Lung cancer is the most common cancer in the world. According to the World Health Organization, there were 2.21 million cases in the year 2020. It is the most common cause of death around the world. Patients have a 13 times better chance of living for five years if they are diagnosed early. Lung Cancer Awareness Month (LCAM) is celebrated every year in November to raise awareness about the disease and continue to challenge the stigma associated with lung cancer.

The goal of the month is to urge individuals to seek medical assistance sooner rather than later, to encourage early diagnosis so that patients have the best chance of a successful treatment, and to emphasise other key aspects that affect patient outcomes. Educating people on the complexity of lung cancer, the vast spectrum of people who are affected, and the harmful effects of lung cancer stigma can aid in earlier diagnosis and better patient treatment. Furthermore, LCAM is also an occasion to highlight therapeutic developments, advocate for global access to care, and, most importantly, demonstrate our support for patients and their loved ones.

Facing the stigma

Lung cancer is often misunderstood to be solely a smoker’s disease. However, more than half of individuals diagnosed are former smokers or non-smokers. This misunderstanding has been associated with poor outcomes due to factors like waiting too long to seek treatment, disease-related distress, a lack of social support, and poor care quality.

What you need to know about Lung cancer

Cancer is a condition in which the cells of the body grow out of control. Lung cancer is cancer that starts in the lungs and spreads throughout the body. Lung cancer begins in the lungs and can spread to the lymph nodes or other organs in the body, including the brain. Cancer that has spread to other organs may extend to the lungs as well. Metastases are the spread of cancer cells from one organ to another.

There are two types of lung cancer:

Small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC) are the two forms of lung cancer. This classification is based on the appearance of tumour cells under a microscope. Making the distinction between these two types of tumours is critical since they develop, spread, and are treated differently.

SCLC accounts for roughly 10% to 15% of all lung malignancies. This form of lung cancer is the most aggressive and fastest-growing of all. Cigarette smoking is highly linked to SCLC. SCLCs spread quickly throughout the body, and they are usually detected after they have spread widely.

The most common type of lung cancer is non-small cell lung cancer (NSCLC), which accounts for roughly 85% of all occurrences. NSCLC is divided into three categories based on the cells detected in the tumour. They are as follows:

• Adenocarcinomas, like other lung cancers, are linked to smoking, this form is also seen in nonsmokers, particularly women, who get lung cancer. The majority of adenocarcinomas develop in the lungs’ periphery. They have a proclivity for spreading to lymph nodes and beyond.
• Squamous cell carcinomas used to be more common than adenocarcinomas, but now they make up around 25% to 30% of all lung cancer cases. Squamous cell tumours are most common in the bronchi of the central chest. This type of lung cancer tends to stay in the lung, spread to lymph nodes, and grow large enough to produce a cavity.
• Large cell carcinomas, also known as undifferentiated carcinomas, are the least prevalent kind of NSCLC, accounting for 10% to 15% of all lung cancer cases. This malignancy has a significant proclivity for spreading to lymph nodes and distant locations.

• Adenocarcinomas, like other lung cancers, are linked to smoking, this form is also seen in nonsmokers, particularly women, who get lung cancer. The majority of adenocarcinomas develop in the lungs’ periphery. They have a proclivity for spreading to lymph nodes and beyond.
• Squamous cell carcinomas used to be more common than adenocarcinomas, but now they make up around 25% to 30% of all lung cancer cases. Squamous cell tumours are most common in the bronchi of the central chest. This type of lung cancer tends to stay in the lung, spread to lymph nodes, and grow large enough to produce a cavity.
• Large cell carcinomas, also known as undifferentiated carcinomas, are the least prevalent kind of NSCLC, accounting for 10% to 15% of all lung cancer cases. This malignancy has a significant proclivity for spreading to lymph nodes and distant locations.

Types of Treatment

Depending on the type of lung cancer and how far it has gone, there are numerous treatment options. Surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these treatments can be used to treat non-small cell lung cancer. Small cell lung cancer is usually treated with a combination of radiation and chemotherapy.

• Surgery: A procedure in which surgeons remove cancerous tissue from the body.
• Chemotherapy: Special medications are used to shrink or kill cancer cells. The drugs can be pills that you consume or medicines that are injected into your veins, or both.
• Radiation therapy: Treatment that involves the use of to kill cancer, high-energy rays (similar to X-rays) are used.
• Target therapy: Drugs are used to stop cancer cells from growing and spreading. The drugs can be taken orally or administered intravenously. Before targeted therapy is employed, tests will be performed to determine if it is appropriate for your cancer type.

In the treatment of lung cancer, doctors from various specialties frequently collaborate. Pulmonologists are doctors who specialise in lung illnesses. Surgeons are medical professionals who carry out procedures. Thoracic surgeons specialise in surgery of the chest, heart, and lungs. Medical oncologists are doctors who specialise in using medications to treat cancer. Radiation oncologists are doctors who use radiation to treat cancer.

It is important to educate yourself and your loved ones about the most common type of cancer so that lives can be saved. If you notice anything unusual contact your doctor immediately.

While the thought of cancer as a whole is daunting, one needs to understand that the disease presents itself in different forms. In essence, cancer is when the cells within a body start to mutate at an unnatural pace & cannot be stopped. While this is the common form, many women suffer from a variation of it called Ovarian Cancer.

Ovarian cancer occurs when cancerous growths begin at the ovaries. The female reproductive system has two ovaries on either side of the uterus. The ovaries are responsible for producing eggs (ova) as well as releasing the hormones estrogen and progesterone.

Ovarian cancer usually goes undetected in the early stages. In most cases, it is detected only when cancer has spread to the pelvis and the abdomen, making it difficult to treat. If the tumors are benign (non-cancerous) in nature, they are confined to the ovaries and do not spread. However, if the tumors are malignant, they spread to the nearby organs and can be fatal.

What are the types of ovarian cancer?

The ovaries are made up of three types of cells. Each of them can develop into a different kind of ovarian cancer. The different types of ovarian cancer are:

Epithelial Tumors: These tumors begin from the cells that cover the outer surface of the ovaries. Over 90% of ovarian cancers are epithelial tumors. These tumors can be benign (non-cancerous), borderline (low malignant potential), or malignant (cancerous).

Ovarian Stromal Tumors: These tumors start from the structural tissue cell that produces the female hormones – estrogen and progesterone. These tumors can be diagnosed at an earlier stage as compared to the other types of ovarian tumors.

Ovarian Germ Cell Tumors: Germ cells are responsible for producing eggs (ova) in women. These tumors begin in the germ cells. Most germ cell tumors are usually benign. This rare type of ovarian cancer tends to occur in younger women.

What are the symptoms of ovarian cancer?

In the early stage, ovarian cancer hardly causes any symptoms, making it difficult to diagnose. Advanced-stage ovarian cancer may cause certain symptoms that may often be mistaken for other common, benign conditions or illnesses.

Some of the most common symptoms of ovarian cancer include bloating/swelling in the abdomen, feeling full quickly while eating, change in bowel habits, pain/discomfort in the pelvic area, frequent urination, and loss of weight.

In case these symptoms are more frequent and don’t go away soon, it is advisable to visit your doctor and rule out the possibilities of ovarian cancer. If you have a family history of ovarian cancer, you may talk to a medical practitioner about the risk of developing the same.

How is ovarian cancer diagnosed?

After analyzing your symptoms, if the doctor suspects ovarian cancer, he/she will conduct a pelvic exam to diagnose the condition. During the pelvic exam, the doctor will insert gloved fingers into the vagina, while simultaneously pressing the abdomen to examine your pelvic organs. The doctor also examines your external genitalia and cervix visually.

The doctor may also suggest imaging tests such as an ultrasound or CT scan to determine the size and the shape of the ovaries. Imaging tests can also show if a mass of tissue is present in the pelvic area, but they cannot confirm if the mass is cancerous. Blood tests may also be conducted to determine the presence of tumor markers that indicate ovarian cancer.

After diagnosing ovarian cancer, the next step would be to stage cancer to finalize the treatment options.

What does ovarian cancer surgery involve?

Surgery is not only one of the main treatment methods for ovarian cancer, but it is also a diagnostic tool to determine ovarian cancer. The goal of the surgery for ovarian cancer is to know how far cancer has spread and removed as much of the tumor as possible. The type of surgery will depend on the stage of cancer and your overall health.

Before the surgery, your doctor may run blood and urine tests a week before to ensure that you are healthy enough to undergo the surgery. Your doctor may also take a chest x-ray and ECG to check your heart rhythm.

Surgery for ovarian epithelial tumors:

The surgery for ovarian epithelial cancer has 2 main goals – staging and debulking.

Staging: This is the first goal of ovarian cancer surgery. Staging is done to see how far cancer has spread from the ovary to the organs. This process involves removing the uterus, along with both the ovaries and fallopian tubes. Some samples of the lymph nodes in the pelvis and abdomen are taken through biopsy. Staging is extremely important as it helps determine the best way to treat the condition.

Debulking: The next goal of the surgery is to remove as much of the tumor as possible. This is known as debulking. This is especially important if cancer has spread across the abdomen. Debulking is done to ensure that no tumor larger than 1 cm is left behind.

Surgery for ovarian stromal tumors:

In most cases, ovarian stromal tumors are confined to just one ovary. So, the affected ovary will be removed through the surgical procedure. If cancer has spread further, the tissues in the surrounding areas may have been removed. The main goal of the surgery for ovarian stromal tumors is to remove cancer.

Surgery for ovarian germ cell tumors:

For most ovarian germ cell tumors, the uterus, both ovaries, and the fallopian tubes are removed. If the cancer is confined to just one ovary and you want to retain the ability to bear children, only the affected ovary and the fallopian tube are removed.

Depending on the type and stage of ovarian cancer, your doctor may choose the type of surgery along with other treatment methods such as chemotherapy. Though the surgery will ensure that the cancerous tumors have been removed, it is important to follow up with your healthcare practitioner on the after-care and the possible side effects of the surgery. You can also incorporate certain lifestyle changes to keep yourself healthy and prevent a relapse.

Cancer refers to a disease/condition in which cells grow and multiply uncontrollably in one organ to form a tumor, and spreads to the other parts of the body. Tumors can either be cancerous or benign. As the name itself suggests, ovarian cancer is a type of cancer that develops in the ovaries. The female reproductive system contains two ovaries on each side of the uterus, which are responsible for producing eggs and estrogen.

Though not common, ovarian cancer causes more deaths among women than other types of cancers. In most cases, it is difficult to detect ovarian cancer in the early stages. Ovarian cancer goes undetected until it has spread to the pelvis, abdomen, and nearby areas.  In this advanced stage, the cancer is quite difficult to treat. However, early-stage ovarian cancer that is confined to the ovaries is more likely to be treated successfully.

Symptoms of Ovarian Cancer

As mentioned earlier, ovarian cancer is unlikely to be detected in the earlier stages as there may be fewer to no symptoms. The early symptoms may also resemble those of other conditions such as premenstrual syndrome and other bladder-related problems. However, it is important to consult with your medical practitioner if the symptoms persist. Some of the most common ovarian cancer symptoms include:

• Immense pain or pressure in the pelvic area
• Abnormal bloating
• Pain in the back/abdomen
• Unusually frequent/less frequent urination
• Changes in bowel habits
• Weight loss
• Loss of appetite
• Nausea
• Shortness of breath
• Fatigue
• Irregular periods
• Vaginal bleeding

The symptoms also tend to change when cancer spreads to other parts of the body. It is important to make an appointment with your doctor if any of these symptoms worry you, or if you have a family history of ovarian cancer.

Causes of Ovarian Cancer

Though there are no definitive causes that lead to ovarian cancer, there are several factors that can increase the risk of one being diagnosed with ovarian cancer. These risk factors include:

Age

The risk of developing ovarian cancer increases with age. Ovarian cancer mostly develops in women who have reached menopause. Around 50% of ovarian cancer cases are found in women above the age of 63.

Family history of cancer

Having a near family member with a history of ovarian cancer, breast cancer, or even colorectal cancer, can increase the risk of developing the condition. This is because cancer can be caused by an inherited mutation in certain genes.

Hormone replacement therapy

Women undergoing Hormone Replacement Therapy (HRT) after menopause is at an increased risk of developing ovarian cancer. The longer the Hormone Replacement Therapy is given, the higher the risk. However, the risk reduces when the treatment stops.

Reproductive history

Women who have undergone one or more full-term pregnancies are at a lower risk of developing ovarian cancer. Breastfeeding also contributes to reducing the risk of ovarian cancer. However, having children after the age of 35 or never having a full-term pregnancy can increase the risk.

Breast cancer

Women diagnosed with breast cancer or with a history of breast cancer are also at a higher risk of developing ovarian cancer. This is mostly due to the changes in the BRCA gene.

Obesity

Obesity has been linked to the risk of developing many types of cancer. Women with a Body Mass Index (BMI) of over 30 are more likely to develop breast cancer.

Androgens

Having high levels of androgens (male hormones), such as testosterone may increase the risk of ovarian cancer. Certain androgens lead to specific types of ovarian cancers.

Prevention of  Ovarian Cancer

Most women are likely to have one or more risk factors that may lead to ovarian cancer. Like most cancers, though there aren’t sure-shot ways to prevent ovarian cancer, you can work towards reducing and eliminating certain risk factors that may lead to the condition. Some of the precautions that can be taken to reduce the risk are:

Maintain a healthy weight

One of the most common causes/risk factors for all cancers is obesity. Ensure that you maintain a healthy weight and follow good dietary habits with an exercise routine to keep your Body Mass Index (BMI) in check.

Avoid HRT

Avoiding Estrogen Hormone Replacement Therapy after menopause can reduce the risk of developing the disease considerably.

Birth control pills

Using oral contraceptives, commonly known as birth control pills, decreases the risk of developing ovarian cancer. Talk to your healthcare provider about birth control pills and which ones may be right for you. However, birth control pills also have certain side effects and other associated risks, so discuss the advantages and disadvantages before taking them.

Gynecologic surgeries

Gynecologic procedures such as tubal ligation and hysterectomy may help in reducing the risk of certain types of ovarian cancer. However, these procedures have to be done only for valid medical conditions, and not just the reduce the risk of ovarian cancer.

Pregnancy and breastfeeding

Women who have had one or more full-term pregnancies before the age of 26 have a lower risk of developing ovarian cancer as compared to women who have not. Breastfeeding helps in lowering the risk even further.

If you or your loved one has been diagnosed with ovarian cancer, you can discuss with your medical practitioner about the various treatment methods. You need to understand the pros and cons of each treatment option before finalizing one. Some of the most common treatment options for ovarian cancer include surgery to remove the tumors, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. Treatment can also vary depending on the type and stage of ovarian cancer.

Though there are no definitive ways to prevent ovarian cancer, it is important to be aware and fully informed of the symptoms. Approach your doctor or healthcare provider immediately, if you notice one or more of these symptoms in you or your loved ones; as early detection saves lives. You can also work towards reducing certain risks associated with the disease by following a healthy lifestyle and taking precautions. Remember, prevention is better than cure!

Ovarian cancer is the third most common gynecological cancer in Indian women. and it causes more deaths than any other cancer of the female reproductive system. While the rate at which ovarian cancer can be fatal is 1 in 108, it is a hopeful statistic that the rate at which women are diagnosed with ovarian cancer has been slowly falling over the past 20 years.

What is Ovarian Cancer?

The ovaries are small organs located on either side of the uterus. Their function is to produce eggs for reproduction. Ovarian cancer can form in different parts of the ovary.

Germ cells are the cells that become eggs in the ovaries, stromal cells make up the substance of the ovary,  and epithelial cells are the outer layer of the ovary. Ovarian cancer can start in either of these cells.

Genetic mutations that are responsible for cancer may be hereditary or they can be acquired. Doctors studying ovarian cancer are trying to identify which of these mutations are responsible for cancer. Ovarian cancer can develop in a woman of any age, although it is most commonly diagnosed in postmenopausal women between the ages of 55 and 64

How is Ovarian Cancer Diagnosed?

Pelvic Exam

Pelvic exams are routine exams done by a primary-care doctor or an obstetrician-gynecologist. The doctor feels for an enlarged ovary and any signs of fluid in the abdomen by inserting two gloved fingers into the vagina and places the other hand on the abdomen. This helps the doctor to check the size, shape, and consistency of the ovaries and uterus.

A pelvic exam may also help to detect conditions such as pelvic inflammatory disease, cervical polyps, uterine fibroids, genital warts, bacterial vaginosis, etc.

While detecting ovarian cancer through a pelvic exam is rare. The doctor may ask the patient to take a few more tests to confirm a diagnosis.

Imaging tests

Transvaginal ultrasound:

Imaging tests such as a transvaginal ultrasound uses high-energy sound waves to detect abnormalities like ovarian tumors, etc. These abnormalities may appear as solid or as a fluid-filled cyst. This imaging test also helps visualize the size of the ovary along with other irregularities in the reproductive system, i.e, the vagina, the bladder, the fallopian tubes.

The doctor or ultrasound technician inserts a probe into the vagina to capture images of the organs and tissues.

Ovarian biopsy: While ultrasound can detect an irregularity, it can’t determine whether the mass is cancerous or not. This requires a biopsy.

A CT scan or a Computed tomography is used to locate a tumor before surgery. It can also help determine tumor size, and detect whether or not the other organs are affected. An MRI or magnetic resonance imaging has greater soft tissue contrast than a CT scan and hence is extremely useful in detecting tumors or recurrences in other organs in the body. This is why an MRI is often used in combination with other tests as part of the evaluation process.

Positron emission tomography-computed tomography or a (PET/CT) scan is sometimes used to help diagnose ovarian, fallopian tube, or peritoneal cancer. The scan can measure a tumor’s ability to use a type of sugar: glucose. Faster growing cells utilize more sugar and show up brighter on this imaging test, hence indicating the presence of cancer.

Treatment of Ovarian Cancer

The treatment of ovarian cancer depends on factors such as the type of ovarian cancer, the stage at which it is, and whether or not one wants to have children in the future.

Surgery

Once the diagnosis and the stage of the cancer are determined, cancer can be removed via surgery. During the procedure, the surgeon will remove all the tissue that contains cancer. The doctor might also ask the patient to take a biopsy to see if cancer has spread.

If one wants to have children in the future but has stage 1 cancer, the surgery can include the following modifications:

• removal of the ovary that has cancer
• biopsy of the other ovary
• biopsies of other tissues and collection of fluid inside of the abdomen for further evaluation
• removal of the fatty tissue, or omentum connecting to the abdominal organs
• removal of abdominal and pelvic lymph nodes

Advanced ovarian cancer surgery

If one has stage 2.3 or 4 cancer, and one does not want to have children in the future, the surgery is more extensive.

The procedure includes the complete removal of areas and organs involved with cancer

Removal of:

• The Uterus
• Both the ovaries and fallopian tubes
• The omentum
• As much tissue that has cancer cells

And biopsies of any tissue that might be cancerous.

Chemotherapy

Chemotherapy is usually the next step after surgery. Medications can be given through the abdomen or intravenously.

Some side effects of chemotherapy can include:

• nausea
• vomiting
• hair loss
• fatigue
• problems sleeping

Ovarian cancer is a serious condition that comes with a physical as well as an emotional toll on the patient. It is highly advisable that one that is experiencing the symptoms mentioned above immediately consult their doctor to undergo the proper diagnosis. It is important to understand every aspect of the condition before going into treatment.

Oral Cancer, as the name itself suggests, refers to cancerous growth in any part of the mouth (oral cavity). It falls under a category of cancers called Head and Neck Cancers. Also known as Mouth Cancer or Oral Cavity Cancer, this type of cancer occurs on the lips, gums, hard and soft palates, inner cheek lining, tongue, the roof of the mouth, under the tongue, and throat. Mouth Cancer can be life-threatening if not diagnosed and treated immediately. Getting quarterly or biannual dental checkups can help in the early detection and treatment of oral cancer.

Make an appointment with your doctor as soon as you spot symptoms such as a lip/mouth sore, a white or red spot in your mouth, a lump in the mouth, difficulty/pain while swallowing, or pain in the mouth. The doctor will ensure if the symptoms are due to other causes such as an infection or any other underlying condition before diagnosing oral cancer.

Who are at risk of getting diagnosed with Oral Cancer?

According to the American Cancer Society, men are at a higher risk of getting diagnosed with oral cancer than women. Oral cancer is most prevalent in men over the age of 40-50. Some of the risk factors that lead to the development of oral cancer include:

Smoking: People who have the habit of frequently smoking cigarettes, cigars, or pipes are more likely to develop oral cancer as compared to people who do not smoke.

Other forms of tobacco use: Apart from smoking, people who consume tobacco by snuffing and chewing are prone to oral cancer in the gums, lips, and inner cheeks.

Alcohol consumption: People who consume excessive amounts of alcohol are six times more likely to get diagnosed with oral cancer as compared to non-drinkers.

Family History: If one or more of your family members are diagnosed with oral cancer, you are more susceptible to the disease.

Weak immune system: It is your immune system that helps your body fight against various illnesses. If your immune system is weak due to certain conditions, you are prone to oral cancer, along with other diseases.

Human Papillomavirus (HPV): The Human Papillomavirus (HPV) is a sexually transmitted virus that could be a major contributing factor for the development of oral cancer.

What are the precancerous conditions of the oral cavity?

A precancerous condition is a condition that involves abnormal cells which lead to an increased risk of developing cancer. Depending on the type of cancer, the precancerous conditions can be few or many.

In oral cancer, precancerous conditions are the changes that take place in the cells of the mouth. These conditions are not developed into cancer yet. But, if left untreated, there are higher chances that these abnormal changes or mutations might advance into oral cancer.

Oral cancer has the two most common precancerous conditions. They are:

Leukoplakia:

Leukoplakia is an unusual grey or white patch that is visible on the tongue, the gums, the inner cheek linings, or the floor of your mouth. If one has leukoplakia, it is not necessary that he/she will develop oral cancer. Depending on the size and shape of the abnormal cells, this precancerous condition may develop into oral cancer.

Erythroplakia:

Erythroplakia is an abnormal red patch or a group of red spots that is visible on the mucous membrane in the mouth, with no definitive cause. This precancerous condition has higher chances of developing into oral cancer as compared to Leukoplakia. Around 50% of these conditions advance into Squamous Cell Carcinoma.

How can you prevent oral cancer?

Though there are no proven measures to prevent oral cancer. However, there are certain precautions one can take to reduce the risk. They are as follows:

Stopping the consumption of tobacco: As mentioned above, tobacco usage is one of the most common risk factors that lead to oral cancer. If you are a regular consumer of tobacco, put a stop to it. Smoking, chewing, or snuffing tobacco is dangerous as it exposes the cells in your mouth to cancer-inducing chemicals.

Moderate alcohol consumption: Excessive alcohol consumption can weaken the cells in your mouth, making you vulnerable to oral cancer. Hence, alcohol should be consumed in moderate amounts or to be completely avoided to lower the risk of mouth cancer.

Avoid excessive sun exposure: Protect the skin on your lips from excessive sunlight by applying lip balm with sun protection as a part of your regimen. You can also wear a broad-rimmed hat when you step out and stay in the shade as much as possible.

The first step to fighting oral cancer is to be mindful of the risk factors and symptoms. Although oral cancer can become fatal if not treated on time, taking precautions to reduce the risk will help keep oral cancer at bay. Have a regular quarterly/biannual check-up with your dentist and ensure proper oral hygiene, because prevention is better than cure!